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Burnett County Office of Zoning Administi ator fC F c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT »• 3 ;W <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and � � °• <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and <br /> regulations of the Spite of Wisconsin. CL <br /> 3 .. <br /> �?� .! .4../Sk.......� A...f1..A.sC................................ . ................................................................................. ....... F n <br /> y . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT .� <br /> �1�..�......M.s.h.r...s. e......s. .....N.... 4. a�.0 w...............ADDRESS s re v i .b............................................ ........ADDRESS <br /> oai iln <br /> m <br /> . . ............................................ ................ <br /> .. .................. <br /> ADDRESSADDRESS................................................................... ........ :r � <br /> ........................................................................................... r� <br /> PHONE . .......................................................................... ........ <br /> PHONE........ Up <br /> ..1.1. WELL DRILLER <br /> ..1�:.6..p..f7'1...7...x.................................................... E � E <br /> . ................................................................................. ........ <br /> :�PL <br /> ........................................................................................... 3= <br /> ADDRESS . ................................................................................. ........ <br /> ADDRESS 0 0 <br /> n O )� <br /> < . <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: P o q <br /> 1. Work: 2. New Building Details No. Bathrooms . ........ Z°. <br /> New Building T No. Bedrooms <br /> ype of Construction: <br /> Addition •••X.. Septic Tank Size Gals. <br /> Sanitary /1•• i <br /> JC... Size ....).. ... ft. x ...... ... ft. 4a. Absorption Field Site: ........ <br /> Filling/Grading .......... Height...........77 $t dries ............... <br /> Moving .......... Area ......R.at............................. Soil Type ........................... ........ '. <br /> r <br /> Mobile Home .......... Slope ................................. ........ :r o <br /> Privy .......... 3. Use (describe exactI '1 •family Perc. Rate .......................... ........ m :.f '• <br /> Well .......... home,garage, motel, etc. Dry Well . ........ 0 i <br /> Subdivision .......... Seepage Trench . ........ o <br /> Camping Unit .......... Privy . . ... ; <br /> .................................................... Seepage Bed � X.. <br /> ----------------------------------------------- in Z <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi 1. A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is Iota ed at �.I �•' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. !`ic" N <br /> r- o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. n <br /> ...................................................................... ........ <br /> JN <br /> rnrn :S <br /> (01IN 0 <br /> C <br /> 0 o <br /> C) <br /> e <br /> '%�I7f// r• v' <br /> ( n V <br /> [N <br /> m J <br /> Z� <br /> °9n � <br /> W � <br /> � m <br /> �v <br /> m c -ouw+ r o c� <br /> ntna < o D0 — — m <br /> LD enc nm any <br /> � y0 � �' 3 <br /> o a+o q D 1 <br /> co <br /> a : y <br /> 0 <br /> ................. S <br /> Signature of Owner or Agent Date <br /> �r =. m N <br /> Remarks ... . ..i ..c. C�7ll:�/.`.:...................................................................................................................... .... <br /> O <br /> O <br /> InspectionDate-X1...... .7:..................... ..... ............ .. 9........ .............................. ... v. m <br /> onin A inisirator0 $ $ $ $ y <br /> 'OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> =d. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has beer issued. A permit may be <br /> misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />